Effective immediately, Harvard Pilgrim now covers medically necessary bronchial thermoplasty, with prior authorization, for certain members 18 and older whose chronic, severe persistent asthma is not well controlled with inhaled corticosteroids and long-acting beta-agonists — and who meet all of the conditions specified in the Bronchial Thermoplasty Medical Review Criteria.
Bronchial thermoplasty, which consists of radiofrequency energy being delivered to the distal airways with the aim of decreasing smooth muscle mass believed to be associated with airway inflammation, is covered for a maximum of three treatment sessions with a recovery period of three weeks or longer between sessions. The treatment is represented by the following newly covered codes:
- 31660 – Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe
- 31661 – Broncoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes
To obtain prior authorization, providers must submit the required written information and meet the criteria as indicated in Harvard Pilgrim’s Bronchial Thermoplasty Medical Review Criteria. Prior authorization requests may be made electronically through HPHConnect or NEHEN, by fax (800-232-0816), or phone (800-708-4414; select the option for the Referral/Authorization Unit).